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Blacks Hit Hardest by Lung Cancer

Report finds they are more likely to develop, die from disease

TUESDAY, April 13 (HealthDay News) -- Blacks are hit the hardest when it comes to both developing and dying from lung cancer.

A new report from the American Lung Association paints a grim picture of how environmental factors, biological factors, cultural attitudes and biases in the health-care system conspire to make this deadly disease even deadlier among members of this minority group.

"Despite lower smoking rates, African-Americans are more likely to develop and die from lung cancer than whites. African-Americans are more likely to be diagnosed later when the cancer is more advanced. Also, African-Americans are more likely to wait longer after the diagnosis to receive treatment or perhaps to refuse treatment and to die in the hospital after surgery," Dr. William J. Hicks, professor of clinical medicine at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus, said during a Monday news conference.

Black men bear an even more disproportionate share of the burden, being 37 percent more likely to be diagnosed with lung cancer and 22 percent more likely to die of the disease than white men.

Only 12 percent of blacks will be alive five years after their lung cancer diagnosis, compared with 16 percent of whites, the ALA report notes.

The report points to a number of factors that could explain the disparity, including differences in socioeconomic status, big business behavior and environmental exposure.

For instance, thanks to concerted marketing efforts by the tobacco industry, blacks have higher rates of smoking menthol cigarettes than other groups. Menthol cigarettes have a higher level of cotinine, which is an indication of how much nicotine a person is absorbing. The U.S. Food and Drug Administration is expected to issue a report on the public health impact of menthol cigarettes in March of 2011.

Education and income levels also play a role. Not only do these factors impact lifestyle choices and access to health care, including health insurance, but they largely determine where blacks are likely to work and live.

According to one study, predominantly black neighborhoods have noticeably higher levels of air pollution than other communities.

And a greater proportion of blacks work in the transportation industry, where they are exposed to diesel fumes, known to contribute to lung cancer risk.

Meanwhile, blacks are less likely to have a gene variant that is targeted by a widely used cancer drug.

The good news is that if individuals, regardless of race, receive equal treatment for lung cancer, their outcomes are likely to be similar.

However, as Hicks pointed out, "the sad truth is that not all patients receive equal treatment and for those who do not, their health outcomes are poorer."

Blacks are also less likely to be seen by experienced or credentialed doctors and hospitals, less likely to have their disease staged, less likely to have surgery and less likely to undergo chemotherapy.

These problems have to do with both patient and provider attitudes.

"We're looking not just at system failures but also at issues that are deeply rooted in the history, culture and beliefs of African-Americans," Hicks said. "This is not post-racial America. For people of color in the United States, race and discrimination are facts of everyday life, and clearly take a toll both mentally and with regard to one's physical health."

There is, first of all, the legacy of the Tuskegee (syphilis) and other medical experiments of the past, in which blacks were exploited by the U.S. health-care establishment. That's made trust in the medical establishment an ongoing issue, the experts said.

And while doctors appear less likely to funnel black patients to the right kind of specialists, blacks are more likely to refuse gold-standard treatment even when it is offered and available, they added.

"This is not an issue that can be solved overnight," said Chuck D. Connor, president and CEO of the American Lung Association. "We've made progress in reducing smoking rates and exposure to secondhand smoke, but there is still much work that needs to be done."

Hicks said he hoped experts and community members could arrive at a new approach that will "hopefully render this very preventable form of cancer to its state of 125 years ago, when it was a very rarely encountered medical issue, primarily before the advent of widespread cigarette smoking."

More information

The American Lung Association has the full report.

SOURCES: April 12, 2010, teleconference with: William J. Hicks, M.D., professor, clinical medicine, Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus; Chuck D. Connor, president and CEO, American Lung Association; Too Many Cases, Too Many Deaths: Lung Cancer in African-Americans

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